Eighteen Things to Know About Medicare for 2018 Updated May 2018

1. Eighteen Things to Know About Medicare for 2018Updated May 2018

2. 18 Things to Know About Medicare • New Medicare Cards • Income Related Monthly Adjustment Amount • Part B Enrollment Periods • COBRA and Medicare • Limited Equitable Relief Medicare & Marketplace • MAGI Medicaid Transition to Medicare • Medicaid Requirement to Enroll in Medicare • Medicare Savings Programs (MSP) • Medicare and QMB

3. 18 Things to Know About Medicare • Repeal of Physical Therapy Cap • Observation and Medicare • Medigap and Medicaid/QMB • Medigap Changes – 2020 • Part D Extra Help/LIS • Limitation on LIS Special Enrollment Period • EPIC and Part D • Medicare Advantage Open Enrollment Period • VA and Medicare

4. New Medicare Cards • Replace HICN (Health Insurance Claim Number) • With Medicare Beneficiary Identifier (MBI) • MBI will be randomly generated identifier • 11 Characters including numbers and upper case letters • Not including Social Security number • Not including current suffixes • Mailing new cards beginning June 2018 • Contact Social Security Admin to confirm address • Beneficiaries in Medicare Advantage plan continue to use plan card

5. Income Related Monthly Adjustment Amount • Income-Related Monthly Adjustment Amount (IRMAA) • Income above $85,000 Single/$170,000 Couple • Subject to higher Part B premium + Part D surcharge • Modified Adjusted Gross Income (MAGI) • AGI + tax-exempt interest income (line 8b) • Based on tax return from two years prior • 2018 Part B Premium based on 2016 tax return • May be able to appeal with Life Changing Event • Change in marital status or Change in work status • 2018 – Lower top 2 Income Thresholds • 2019 - New Threshold $500,000/$750,000

6. Enrollment

7. Part B Enrollment Periods • Initial Enrollment Period (IEP) • 7 months surrounding month you turn 65 • Delays Part B if enroll after month turn 65 • Special Enrollment Period (SEP) • Must have been covered continuously through active employment since first Medicare eligible • OR enroll in IEP and then drop Part B when coverage through active employment begins • 8 months following loss of active employment • General Enrollment Period (GEP) • January – March (Effective July 1) • Late enrollment penalty (10% per 12 months)

8. COBRA and Medicare • Does not extend Medicare enrollment period • People with COBRA when first Medicare eligible • And who do NOT have Part B • NOT entitled to Part B Special Enrollment Period • Can only enroll in General Enrollment Period • Even if later covered under Active/Current employment • Even if COBRA is free/subsidized by former employer • COBRA may not continue to pay as primary • If you do not enroll in Medicare when first eligible

9. Limited Equitable Relief – Medicare and Marketplace • Available now through September 30, 2018 • Individuals receiving premium/cost-sharing assistance with Qualified Health Plan (QHP) • Who later become Medicare eligible • May have delayed Part B • Because QHP with assistance more affordable • BUT actually no longer eligible for assistance • AND cannot delay Part B without penalty • Can request Equitable Relief to enroll in Part B • And/or waive late enrollment penalty • Contact Social Security for Equitable Relief

10. Medicaid/MSP

11. MAGI Medicaid Transition to Medicare • People with Medicaid becoming eligible for Medicare • MAGI Medicaid • Higher income limit, no resource test • Medicaid for people with Medicare • Lower income limit, resource test • Receive form from LDSS to screen for Medicaid/MSP • May continue to receive Medicaid for several months • If Parent/Relative Caretaker, can continue with MAGI Medicaid budgeting • Request reimbursement for Part B premium in this period • Enroll in Part A and Part B and Part D drug plan • Will be disenrolled from Medicaid plan • Will receive Full Extra Help automatically

12. Medicaid Requirement to Enroll in Medicare • NYS requiring Medicare eligible Medicaid recipients to enroll in Medicare • As condition of continuing to receive Medicaid • Medicare Eligibility vs. Premium-Free Part A • Eligible for Medicare if US citizen • Or legal permanent resident for 5 years • Eligible for premium-free Part A • 40 quarters/10 years work history • Part A Buy-In • QMB will pay both Part A and Part B premium

13. Medicare Savings Programs • Qualified Medicare Beneficiary (QMB) • $1,032/month individual - $1,392/month couple • Covers premiums, deductibles and coinsurance • Specified Low Income Beneficiary (SLMB) • $1,234/month individual - $1,666/month couple • Covers Part B premium ONLY • Qualified Individual 1 (QI-1) • $1,386/month individual - $1,872/month couple • Covers Part B premium ONLY • Can deduct health insurance premiums from income • NO resource limit for NYS residents • SLMB/QI can be effective retroactive up to 3 months • Automatically qualify for Part D Full Extra Help

14. Original Medicare

15. Medicare and QMB • Misunderstanding: Providers can bill beneficiaries with QMB if do not accept Medicaid • Providers not allowed to bill beneficiary for any Medicare Part B cost-sharing • Regardless of whether in Original Medicare or Medicare Advantage • Regardless of whether provider accepts Medicaid • Regardless of whether provider receives any payment from Medicaid • NEW: Starting July 2018 • Beneficiary MSN (Medicare Summary Notice) and Provider RA (Remittance Advice) will reflect QMB • And MSN $0 cost-sharing for beneficiary responsibility

16. Repeal of Physical Therapy Cap • Retroactive to January 2018 • Prior to 2018, Limit on Physical, Speech and Occupational Therapy • Included therapy provided in office, home (if not receiving Medicare covered home health care) and outpatient hospital • Automatic Exceptions available based on condition or situation • $2,010 Threshold • Therapist must certify medical necessity • $3,000 Threshold • Medicare may review services

17. Observation and Medicare • Medicare Outpatient Observation Notice (MOON) • Notice that beneficiary is outpatient, not inpatient • Receiving observation services more than 24 hours • MOON Required as of March 8, 2017 • Observation services covered under Part B • With fixed co-pay rather than 20% coinsurance • Drugs covered under Part D • Hospital pharmacy probably out of network • Need to pay up to charge and submit claim to Part D plan • Part D plan will only reimburse up to their rate • Days under observation don’t count toward 3-day stay • Required for coverage of Skilled Nursing Facility

18. Medigap

19. Medigap and Medicaid/QMB • Medigap plans are Guaranteed Renewable • Can continue Medigap even if qualify for Medicaid/QMB • But cannot purchase new Medigap plan • If receive Medicaid/QMB • Because Medicaid/QMB duplicate Medigap benefits • Beneficiary with Medigap • Who later qualifies for Medicaid/QMB • May want to keep Medigap plan also • To insure access to most providers • Medigap may pay entire Medicare cost-sharing • With Medicaid/QMB, providers may need to “write off” balance after Medicare

20. Medigap Changes - 2020 • NEW: 2020 • Newly eligible beneficiaries cannot purchase Medigap plan that covers Part B deductible • Currently Plans C and F • Replaced by Plans D and G • And new High Deductible Plan G • For newly eligible beneficiaries • Current beneficiaries can keep their C, F or High Deductible Plan F • A newly eligible beneficiary is defined as an individual who is neither a person who: • Has attained age 65 before January 1, 2020; or • Was entitled to Medicare Part A benefits by disability or ESRD before January 1, 2020

21. Part D

22. Part D Extra Help/LIS • Part D Extra Help/LIS – Things to Know • Automatic Extra Help/LIS • Medicaid and/or Medicare Savings Programs • Medicaid Spenddown • Meet spenddown for 1 month • Get LIS for calendar year • Meet spenddown for 1 month (July – December) • Get LIS for all of following year • Apply for Extra Help/LIS • Dependent relatives increase family size/income limits (Relative’s income not counted)

23. Limitation on Extra Help/LIS Special Enrollment Period • NEW: Limitation on Extra Help/LIS Special Enrollment Period (SEP) • Currently beneficiaries with LIS can change Part D/MA plans at any time • NEW: Will be limited to 1 change per quarter • During first 9 months of year • Limited to Annual Election Period in last quarter • October 15 – December 7

24. EPIC and Part D • Fee and Deductible Plans • Either pay Fee or meet Deductible • On sliding scale based on income • EPIC supplements all Part D plans • BUT does not cover Part D Deductible • EPIC requires enrollment in Part D • BUT does not require enrollment in Part D first • Special Enrollment Period • Available for all EPIC members • One election every calendar year • Can enroll or switch plans

25. Medicare Advantage Open Enrollment Period • Replaces Medicare Advantage Disenrollment Period (January 1 – February 14) • NEW: Beginning in 2019 • January – March • Medicare Advantage (MA) plan change • Change from MA plan to MA plan or to Original Medicare • With or without Part D • CANNOT change from Original to MA plan • One change effective 1st of following month

26. VA and Medicare • Medicare Misunderstanding: Veterans do not need to enroll in Medicare • Cannot delay Part B • Subject to late enrollment penalty • Counted toward Medigap waiting period • For pre-existing conditions • Can delay Part D • VA is considered to be creditable drug coverage • Allows for Part D SEP to disenroll from Part D plan • Including Medicare Advantage plan with Part D